Childhood growth restriction can lead to lasting developmental changes, increasing susceptibility to chronic diseases and neurodegenerative conditions in adulthood. High-intensity interval training (HIIT) elevates brain-derived neurotrophic factor (BDNF) levels more effectively than moderate-intensity continuous exercise, supporting neuroplasticity. Building on these findings, this study aimed to determine whether HIIT could enhance neuroplasticity-related protein expression in the brains of postnatally growth-restricted (PNGR) mice. Friend leukemia virus B mouse pups born to normal-protein and low-protein-fed dams were cross-fostered at postnatal day (PN) 1 to establish two groups: PNGR mice and control mice (CON). At PN 21, all pups were weaned onto a normal-protein diet and assigned to either a HIIT group (training group [TRD]) or a sedentary group (SED). At PN 45, a maximal exercise performance test was conducted to determine HIIT intensities. Based on these results, mice performed treadmill HIIT 5 d·wk -1 for 4 wk, with alternating intervals of 8 min at 85% and 2 min at 50% of maximal exercise capacity, totaling 60 min per session. At PN 73, all mice were euthanized, and cerebrum tissue was collected for Western blot analysis of BDNF, tropomyosin receptor kinase B, growth-associated protein 43, and synaptophysin protein expression. Despite significant body mass reductions observed in both CON and PNGR groups after HIIT, neuroplasticity-related protein expression did not increase in PNGR mice. The PNGR group exhibited consistently lower tropomyosin receptor kinase B and reduced BDNF and growth-associated protein 43 levels compared with CON mice, indicating a limited neuroplastic response to exercise. Contrary to expectations, HIIT did not elevate neuroplasticity markers in PNGR mice, highlighting the lasting impact of early-life growth restriction on brain plasticity and suggesting the need for alternative interventions.

High intensity interval training characteristics associated with exercise enjoyment in adults: a systematic review and meta-analysis.

The study aimed to investigate whether a 5-week sprint interval training (SIT) could improve neuromuscular function (NMF), alter electromyographic activity (EMG), and attenuate fatigability, ultimately resulting in improved cycling performance during constant work rate (CWR) exercise within the severe-intensity domain. Twenty-one recreational active males were randomly assigned into a SIT group (SITG; n=11) that underwent 5weeks of SIT (4-6, 30-s Wingate bouts) and a control group (CON; n=10). The study was conducted in a parallelindependent group study. At the pre- and post-training periods, participants performed (i) a ramp incremental test; (ii) CWR exercise at 150% of the pre- and post-training power output at the respiratory compensation point (RCP-PO) until task failure, with the NMF assessed at baseline (NMFBL) and immediately after exercise [isometric maximal voluntary contraction+peripheral nerve stimulations with measurement of the force and EMG]. Pre- and post-training NMFBL was used to assess isometric performance, whereas the difference between NMFBL and NMF after exercise was used to assess performance fatigability. Furthermore, EMG was also measured during exercise. SITG showed a significant increase in absolute RCP-PO compared to CON (+11.0% vs. -0.7%, respectively; p<0.01), performing the post-training CWR at a greater power output than in pre-training. Despite this, no significative differences were observed for the NMFBL, fatigability, and EMG during CWR exercise. These findings suggest that SIT may improve EMG activity efficiency (i.e.,requiring the same level of activation to sustain a greater absolute power output) during CWR exercise within the severe-intensity domain. However, NMFBL, fatigability, and time-to-task failure performance remained unchanged.

Exercise training is an effective non-pharmacological strategy for reducing blood pressure; however, current guideline recommendations are largely derived from studies reporting resting clinic blood pressure rather than ambulatory blood pressure (ABP), which provides greater prognostic value. Comparative evidence on the effects of different exercise modalities on ABP remains limited. To compare the effects of major exercise modalities on 24-h systolic ABP using a Bayesian network meta-analysis, and to outline practical implications for antihypertensive exercise prescription. PubMed (MEDLINE) and the Cochrane Library were searched for randomized controlled trials published before January 2025 reporting changes in 24-h systolic ABP following an exercise intervention of at least 2 weeks' duration. Eligible studies included adults and compared aerobic exercise training (AET), resistance training (RT), high-intensity interval training (HIIT), combined training (CT), or isometric exercise training (IET), with a non-exercise control or another exercise modality. Bayesian network meta-analyses were conducted, with interventions ranked using surface under the cumulative ranking curve (SUCRA) values. Twenty-five studies (1096 participants) met inclusion criteria; 16 were included in the network meta-analysis. AET and HIIT reduced 24-h systolic ABP (-4.77 mmHg and -6.86 mmHg), with a smaller reduction following RT (-2.25 mmHg). Data were insufficient to analyse comparative effects for CT or IET. In the Bayesian network, rank order of effectiveness based on SUCRA values was HIIT (91.4%), AET (68.2%), and RT (35.4%). No statistically significant comparative differences were observed between exercise modalities. This Bayesian NMA demonstrates HIIT and AET as effective for reducing 24-h systolic ABP, supporting their role in hypertension management. However, the limited scale and connectivity of available trials restrict definitive comparisons between wider exercise modes. Larger, well-designed head-to-head trials incorporating ABP outcomes are needed to clarify the relative effectiveness of different exercise strategies and to better inform evidence-based exercise prescription for blood pressure management. Registration:PROSPERO: CRD420251177743.

Exercise interventions for physical function, psychological health, and quality of life in patients with myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia: A systematic review and network meta-analysis.

Li, H, Yang, Q, and Wang, B. Effects of different training-intensity distribution models on maximal oxygen uptake and time-trial performance in endurance athletes: A Bayesian network meta-analysis. J Strength Cond Res 40(7): e755-e764, 2026-Training intensity distribution (TID) describes how an athlete's total training time is allocated across low-, moderate-, and high-intensity zones. Training intensity distribution models are central to endurance training, but their relative effectiveness across key performance outcomes remains unclear. We conducted a Bayesian network meta-analysis to compare the effects of common TID models on maximal oxygen uptake (V̇ o2 max) and time-trial (TT) performance. Randomized controlled trials were retrieved from PubMed, Web of Science, EBSCO, the Cochrane Library, and Scopus, with risk of bias assessed using the Cochrane tool. Compared with polarized training, no other TID model showed a definite advantage for improving V̇ o2 max or TT performance, because all 95% credible intervals crossed zero. However, Bayesian posterior ranking indicated that lactate-threshold training (THR) was most likely to be the optimal model for V̇ o2 max (rank-1 probability = 65.4%, SUCRA = 84.8%), whereas high-intensity interval training (HIT) was most likely to optimize TT performance (rank-1 probability = 53.9%, SUCRA = 81.5%). Age, training status, intensity-quantification method, intervention duration, and sex were identified as potential moderators. Cluster analysis showed both shared and sport-specific TID patterns. Overall, coaches should tailor TID strategies to athlete characteristics and sport demands, with THR and HIT emerging as the most promising options for targeting V̇ o2 max and TT performance, respectively.

Nocturnal hypertension is the blood pressure (BP) phenotype most strongly associated with cardiovascular morbidity and mortality, yet no specific therapeutic strategy has been established. Physical activity effectively lowers BP, but the impact of different exercise modalities on nocturnal BP remains unclear. In this randomized clinical trial, 66 patients with nocturnal hypertension were assigned to 12 weeks of supervised high-intensity interval training (HIIT, n = 38) or isometric resistance training (IRT, n = 28). The primary outcome was the change in nocturnal SBP measured by ambulatory blood pressure monitoring (ABPM). Fourteen participants (21%) did not complete the intervention, leaving 52 patients (73% women; mean age 49 ± 12 years; BMI 33 ± 7 kg/m 2 ) for analysis. Exercise training significantly reduced office BP (-5.8 ± 18/-3.6 ± 10 mmHg, P < 0.05) and 24-h ABPM (-4.2 ± 12/-2.9 ± 7 mmHg, P < 0.05), mainly driven by nocturnal BP reductions (-6.9 ± 12/-4.7 ± 7 mmHg, both P < 0.001). The HIIT group showed a significantly greater decrease in nocturnal SBP compared with IRT (-9.8 ± 12.3 vs. -2.7 ± 10.4 mmHg, P < 0.001). After adjustment by sex, BMI, age, and antihypertensive treatment, HIIT lowered nocturnal systolic ABPM by -7.5 ± 3.3 mmHg (95% CI: -14.2 to -0.8; P = 0.030) more than IRT. Supervised exercise training, particularly HIIT, significantly lowers nocturnal BP in patients with nocturnal hypertension, regardless of weight loss. These findings suggest HIIT as a promising nonpharmacological therapeutic option for this high-risk phenotype.

Optimal exercise strategies to improve HDL-C in metabolic syndrome: A systematic review with pairwise, network, and dose-response meta-analysis.

MicroRNA-146a (miR-146a) is an important regulator of inflammation and insulin sensitivity in obesity and type 2 diabetes mellitus (T2DM). Changes in miR-146a expression in obesity and diabetes are tissue- and disease-context dependent; however, most studies have consistently reported reduced miR-146a expression in T2DM. Reduced miR-146a expression in T2DM contributes to chronic inflammation and metabolic dysfunction, whereas its expression in obesity appears to be more variable and context-dependent. Physical activity modulates miR-146a expression, with high-intensity interval training, resistance training, and combined aerobic-resistance exercise generally increasing its levels and suppressing NF-κB-mediated inflammation. In contrast, long-term exercise may normalize elevated miR-146a expression in obesity by reducing inflammatory burden. These changes are associated with improvements in insulin sensitivity, lipid metabolism, and vascular function. Overall, miR-146a may serve as both a biomarker and a mediator of the anti-inflammatory and metabolic benefits of exercise, although its response depends on exercise characteristics and individual physiological status.

Exercise disrupts hormonal balance, driving physiological adaptations. However, inconsistent findings exist due to methodological limitations. To address this, this study simultaneously profiled 16 steroid hormones via LC-MS/MS in response to three distinct exercise modalities - moderate intensity continuous exercise (MICE), resistance exercise (RE), and High-intensity Intermittent Exercise (HIIE) - using a randomized crossover design. Ten healthy adult males completed HIIE (> 80% V̇O2max), MICE (< 65% V̇O2max) and whole-body RE (3 sets×10 reps at 70% 1RM with 90s rest) in a randomized sequence. Blood samples were collected pre-, 10min post-, and 2h post-exercise, and analyzed for glucose, lactate, and steroid hormones. DHEA and androstenedione increased post-exercise following MICE, HIIE (both P < 0.01), and RE (P < 0.05), but declined below rest by 2h. Estrone increased 2h post-RE vs. post-exercise (P < 0.01), and 2h post-HIIE vs. rest (P < 0.01). Only HIIE elevated cortisol (P < 0.001) and cortisone (P < 0.01) post-exercise, while cortisol fell below rest at 2h across all modalities (P < 0.001). HIIE also raised corticosterone (P < 0.001), exceeding post-MICE (P < 0.01) which showed sub-resting corticosterone at 2h post-exercise (P < 0.01). All exercise modalities increased aldosterone (P < 0.01), with greater responses in MICE and HIIE than RE. At 2h, all protocols elevated the testosterone: cortisol ratio (P < 0.05). RE and HIIE altered sex hormone ratios, decreasing testosterone:17b-estradiol and androgens: estrogens, and increasing estrogens: progesterone (P < 0.05). These exploratory findings demonstrate mode-specific acute hormonal responses in young males. Future studies should explore circulating hormonal tissue interactions to clarify potential functional adaptations.

Purpose Post-exercise recovery is a critical window for physiological adaptation, with the autonomic nervous system (ANS) playing a key regulatory role. However, whether long-term training with different modalities systematically influences post-exercise ANS recovery remains unclear. This study investigated the long-term effects of moderate-intensity continuous training (MICT), high-intensity interval training (HIIT), and resistance training (RT) on post-exercise ANS recovery assessed by heart rate variability (HRV) in healthy adults. Methods Three independent cohorts completed 12 weeks of MICT, HIIT, or RT (3 sessions per week). 5-minute continuous HRV data were collected immediately after each session. Recovery slopes of the root mean square of successive differences (RMSSD) and low-frequency/high-frequency power (LF/HF) ratio were calculated. Linear mixed-effects models analyzed trends in recovery slopes across training weeks, with pre-exercise resting HRV and prior-night insomnia score as covariates. Results A total of 43 participants (MICT: n = 13; HIIT: n = 16; RT: n = 14) completed the intervention, yielding 1393 training observations. RMSSD recovery slope decreased significantly in MICT (b=-0.165, P = 0.003), but not in HIIT (b = 0.019, P = 0.680) or RT (b=-0.037, P = 0.452). Between-group comparisons showed a significant difference between HIIT and MICT (Δb = 0.184, P = 0.030). Pre-exercise resting RMSSD (β = 0.022, P < 0.001) and prior-night insomnia score (β = 0.052, P = 0.021) significantly influenced RMSSD recovery slope. No observable trend was detected in LF/HF ratio recovery slopes. Conclusion Long-term training with different exercise modalities differentially affects post-exercise ANS recovery. MICT potentially promotes economical autonomic adaptation; HIIT maintains rapid recovery capacity; RT exerts weaker effects. Pre-exercise resting RMSSD and sleep quality may serve as practical markers for daily training monitoring.

Female athletes wearing a sports hijab may experience greater heat strain during high-intensity intermittent exercise. This study examined the effects of menthol mouth rinse (MEN), neck cooling (NEC), and their combination (NEC + MEN) on repeated-shuttle sprint performance, physiological responses, and perceptual outcomes in hijab-wearing female futsal players exercising in hot-dry indoor conditions. Twenty-five female players completed four randomized crossover trials conducted in a hot-dry environment (34 ± 1°C, 20-30% RH; WBGT ≈ 31°C). Each trial involved a 10 × 30-m out-and-back repeated-sprint test every 30s. Outcomes were mean/best sprint time, fatigue index, whole-body thermal sensation/comfort, RPE, and post-test HR, sweat loss, and pre-trial rectal temperature. Mean sprint time was faster in NEC and MEN + NEC than PLA (p < 0.001 for both) and modestly faster in MEN than PLA (p = 0.045). Best sprint time was faster in NEC and MEN + NEC than PLA (p < 0.001), whereas MEN did not differ from PLA (p = 1.000). Fatigue index was lower in MEN, NEC, and MEN + NEC than PLA (all p ≤ 0.002). Post-RSA heart rate and rectal temperature did not differ between conditions (p ≥ 0.553). Sweat loss was lower in MEN + NEC and NEC than PLA (p ≤ 0.049). Thermal sensation/comfort and RPE increased over time (p < 0.001) but were lower in NEC and MEN + NEC than PLA (condition effects, p < 0.01). Neck cooling enhances repeated-shuttle sprint performance and reduces perceived thermal strain in hijab-wearing female futsal players in hot-dry indoor heat. Menthol provides smaller performance benefits, and MEN + NEC is broadly comparable to NEC alone for primary performance outcomes. IRCT87477.

Feuerbacher, JF, Jacobs, MW, Dragutinovic, B, Rehbein, P, and Schumann, M. Effects of prolonged combined aerobic and strength training on movement velocities during a strength loading bout: targeting same versus separate muscle groups. J Strength Cond Res XX(X): 000-000, 2026-Combined aerobic and strength training may impair explosive strength performance, especially when targeting the same muscle groups. This study aimed to assess the effects of prolonged combined aerobic and strength training on movement velocities and velocity loss during a strength loading bout when the aerobic and strength training target the same vs. separate muscle groups. Thirty-two men participated in a 12-week intervention, divided into 3 groups: (a) LHLS (lower-body high-intensity interval training (HIIT) and strength training), (b) LHUS (lower-body HIIT and upper-body strength training), and (c) LSUS (lower- and upper-body strength training). Changes in the area under the mean propulsive velocity (MPV) and velocity-loss curves during strength loadings were analyzed pre- and postintervention. Squat performance was compared between LHLS and LSUS, while bench press performance was compared between LHUS and LSUS. The level of significance was set at ρ ≤ 0.05. During bench press loading, no statistically significant main effects for group (p = 0.225), for timepoint (p = 0.170), nor group × timepoint (p = 0.943) were observed for MPV. In squat loading, a statistically significant main effect for timepoint was found (p = 0.020), with a decrease in MPV for LHLS postintervention (p = 0.006). The interaction between group and timepoint was not statistically significant (p = 0.083). No statistically significant main effects for group (p = 0.110, p = 0.076), for timepoint (p = 0.590, p = 0.244), nor group × timepoint (p = 0.626, p = 0.239) were observed for velocity loss in either bench press or squat loading. These findings suggest that explosive strength performance may be more susceptible to interference when aerobic and strength training target the same, rather than different, muscle groups.

Sedentary lifestyle and obesity are considered to be significant risk factors that create a pathway for the appearance of the 'sedentary cardiac phenotype' consisting of cardiac atrophy, myocardial stiffening, and altered haemodynamics. Although exercise training has the potential to reverse this detrimental process, the literature data on the magnitude of improvements and the certainty of evidence are inconsistent. This systematic review and meta-analysis aimed to evaluate the effects of exercise interventions on cardiac morphology, systolic/diastolic function, and haemodynamics in sedentary and obesity-prone individuals. In accordance with the PRISMA guidelines, the study was conducted by searching the PubMed, Web of Science, and Scopus databases from 1990 to 2025 without applying any filters, using Covidence software. As a result of this comprehensive search, 12 randomised controlled trials (RCTs; N=477) comparing exercise training with a control group in sedentary individuals were included in the analysis. Data were pooled using the Standardised Mean Difference (SMD) and a random-effects model. Publication bias and methodological robustness of the results were tested using the Egger regression test, the Trim-and-Fill method, and Leave-One-Out sensitivity analysis. The certainty of the evidence was graded using the GRADE system. Exercise training was associated with significant reductions in resting HR and SBP, indicating robust improvements in the haemodynamic profile. Notably, stroke volume (SV) demonstrated a highly significant increase. While global LVEF improvements remained at the statistical threshold, myocardial contractility-measured by the S' wave-improved significantly. Furthermore, exercise induced a physiological, athlete's heart-like eccentric hypertrophy, evidenced by significant increases in LVMass and LVEDV without pathological wall thickening. Diastolic adaptations were also marked by substantial improvements in the E/A ratio and IVRT. Subgroup analyses indicated that high-intensity interval training (HIIT) was the superior modality for diastolic and structural adaptations, whereas aerobic exercise was the most effective for blood pressure reduction. Importantly, meta-regression analyses revealed two key findings: first, improvements in blood pressure and diastolic function occurred independently of weight loss; second, structural and functional adaptations were linearly associated with improvements in body composition. Exercise training may reduce selected cardiovascular adverse effects associated with obesity and a sedentary lifestyle, particularly in terms of haemodynamic and diastolic parameters. Structural cardiac adaptations, however, may be more closely linked to changes in BMI. Findings specific to HIIT and aerobic training modalities are exploratory in nature and should be interpreted with caution due to heterogeneity and the limited number of studies. The systematic review protocol was preregistered in PROSPERO (CRD420261292046).

Irisin is an exercise-induced myokine that has been proposed to exert beneficial effects on metabolic health. However, its response to different exercise training modalities in individuals with overweight or obesity remains inconsistent. This systematic review and meta-analysis primarily aimed to evaluate the effects of various exercise interventions on circulating irisin levels as the primary outcomein overweight and obese adults. Additionally, we assessed changes in other selected myokines and metabolic markers as secondary outcomes to provide a better understanding of exercise induced physiological adaptations. A systematic search was conducted in Web of Science, EMBASE, Cochrane Library, PubMed, SCOPUS, and Google Scholar (up to 22 April 2025) to identify randomized controlled trials (RCTs) evaluating the effects of different exercise training protocols (aerobic, resistance, concurrent, and high-intensity interval training) on circulating irisin levels in adults with overweight or obesity. The primary eligibility criterion to include studies was the measurement of circulating irisin. Within the RCTs meeting this criterion, we additionally extracted data on selected myokines (follistatin, myostatin, and FGF21) and metabolic markers (glycemic control and lipid profiles) when reported. These secondary outcomes were analyzed to contextualize irisin responses within broader metabolic adaptations, but no separate systematic search was performed for these variables. Pooled effect sizes were calculated using random-effects models and expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Using the median split technique, subgroup analyses were computed according to exercise training modality. A total of 50 studies comprising 1780 participants (1104 in exercise groups and 676 in passive control groups) were included. For the primary outcome, exercise training was associated with a significant increase in circulating irisin (SMD 0.62, 95% CI 0.39-0.85, p < 0.001, n = 76 arms, 1721 subjects) compared with passive controls. Among the secondary outcomes, training was also associated with increases in high-density lipoprotein cholesterol (SMD 0.25, 95% CI 0.03-0.47, p = 0.030], n = 18 arms, 420 subjects), follistatin (SMD 0.89, 95% CI 0.37-1.41, p = 0.008, n = 7 arms, 141 subjects), and fibroblast growth factor 21 (FGF-21; SMD 1.00, 95% CI 0.10-1.91, p = 0.003, n = 13 arms, 280 subjects). In contrast, exercise training did not significantly affect myostatin levels (SMD - 0.45, 95% CI - 1.07 to 0.18, p = 0.160, n = 11 arms, 283 subjects). Additionally, exercise training significantly reduced fasting blood glucose (SMD - 0.61, 95% CI - 0.89 to - 0.33, p < 0.001, n = 28 arms, 696 subjects), insulin (SMD - 0.80, 95% CI - 1.11 to - 0.50, p < 0.001, n = 24 arms, 566 subjects), homeostatic model assessment for insulin resistance (SMD - 0.75, 95% CI - 1.08 to - 0.43, p < 0.001, n = 28 arms, 609 subjects), hemoglobin A1C (HbA1C) (SMD - 0.96, 95% CI - 1.23 to - 0.70, p < 0.001, n = 12 arms, 275 subjects), and low-density lipoprotein cholesterol (SMD - 0.38, 95% CI - 0.74 to - 0.02, p = 0.040, n = 18 arms, 443 subjects). Exploratory subgroup analysis showed significant increases in irisin following resistance training (SMD 0.88[95% CI, 0.44 to 1.33], [p=0.001], n=21 arms, 537 subjects, I2 = 79% [p=0.001]), high-intensity interval training (SMD 0.61[95% CI, 0.13 to 1.09], [p=0.001], n=17 arms, 346 subjects, I2 = 75% [p = 0.001]), and concurrent training (SMD 0.42[95% CI, 0.16 to 0.68], [p=0.002], n=18 arms, 356 subjects, I2 = 21% [p=0.20]). Although resistance training demonstrated numerically larger effects, differences between exercise modalities were not statistically significant (p > 0.05). Regular exercise is an effective intervention for increasing circulating irisin levels and favorably modulating other myokines such as follistatin and FGF-21 in adults with overweight or obesity. Resistance training showed larger numerical effects, but the differences between exercise types were not statistically significant.These adaptations, alongside improvements in metabolic markers, support the role of structured exercise as part of a comprehensive strategy for improving metabolic health in this population. PROSPERO CRD42025637476.

Physical exercise mitigates amyloid beta-driven muscle degeneration in Alzheimer's disease.

The nephron index provides a non-invasive and theoretical estimate of the functional nephrons based on the assumption that serum fibroblast growth factor 23 (FGF23) concentrations correlate with phosphate excretion per functional nephron. This study aimed to investigate the effects of exercise on the nephron index under different conditions. Nine middle-aged adults performed exercise under three experimental conditions: moderate-intensity continuous exercise (MICE), high-intensity intermittent exercise (HIIE), and moderate-intensity intermittent exercise (MIIE). Blood and urine samples were collected before exercise, immediately after exercise and 60 minutes post-exercise. The nephron index was assessed using blood and urine phosphate and creatinine concentrations, serum FGF23 levels, and the estimated glomerular filtration rate. A significant time effect was observed for the log-transformed nephron index (p = 0.012, ηp² = 0.42). The log-transformed nephron index increased immediately after exercise (p = 0.059) and 60 minutes post-exercise (p = 0.008) across MICE, HIIE, and MIIE conditions. Additionally, urinary fractional excretion of phosphate (defined as the ratio of phosphate to creatinine clearance) significantly increased at 60 minutes post-exercise across all conditions (p = 0.038). These findings suggest that a single bout of exercise may result in acute beneficial effects on renal microcirculation. These results suggest that a single bout of exercise may influence nephron responsiveness in middle-aged individuals. However, as this is a preliminary study, further investigations are warranted to confirm the physiological relevance of the nephron index under dynamic conditions.

Exercise is a cornerstone of type 2 diabetes mellitus (T2DM) management; however, the comparative efficacy of specific modalities, optimal dosages, and associated exerkine responses remains incompletely defined. This study aimed to synthesise evidence on the effects of different exercise types and doses on glycated haemoglobin (HbA1c) levels and to explore modality-specific patterns of exerkine regulation in adults with T2DM. A systematic review and Bayesian evidence synthesis of randomised controlled trials was conducted up to October 2025. Pairwise, network, and model-based dose-response meta-analyses were employed to evaluate the effects of eight exercise modalities on HbA1c levels. Exploratory analyses were performed to evaluate changes in circulating adiponectin, brain-derived neurotrophic factor (BDNF), interleukin-6, leptin, resistin, and tumour necrosis factor-α levels. A total of 127 trials involving 8,744 participants were included. Network meta-analysis ranked combined mind-body resistance training (tai chi + elastic bands) and high-intensity interval training (HIIT) as the most effective modalities for reducing the level of HbA1c (surface under the cumulative ranking curve: 85.9% and 78.6%, respectively). An L-shaped nonlinear dose-response relationship was observed, with the majority of the clinical benefit being achieved at 600 MET-min/week (mean difference: -0.57%; 95% credible interval: -0.72, -0.42) and a plateau beyond approximately 1,000 MET-min/week. Exploratory exerkine analyses suggested modality-specific signatures; specifically, HIIT was associated with greater increases in adiponectin levels, whereas resistance-based interventions trended towards greater reductions in interleukin-6 and tumour necrosis factor-α levels. In pairwise comparisons versus the control, no significant overall changes were detected for adiponectin, BDNF, interleukin-6, or resistin. In adults with T2DM, exercise efficacy varies by modality and follows a dose-plateau pattern. The achievement of 600 MET-min/week produces a meaningful reduction in HbA1c levels, with diminishing returns being observed beyond approximately 1,000 MET-min/week. MBRT and HIIT are the most promising modalities, although the evidence concerning MBRT remains preliminary in nature. Modality-specific exerkine patterns were observed; specifically, HIIT ranked highest for adiponectin, whereas RT ranked highest for IL-6 and TNF-α. These findings inform evidence-based, personalised exercise prescription in T2DM patients.

ObjectiveThis study aimed to investigate the effects of different types of exercise on body composition in women with overweight or obesity and to compare the relative effectiveness of these interventions using a systematic review and network meta-analysis.DesignSystematic review and network meta-analysis using the CINeMA (Confidence in Network Meta-Analysis) approach.Data sourcesPubMed, Embase, CINAHL, SportsDiscus, the Cochrane Library, Web of Science and Scopus were searched through September 2025.Eligibility criteria for selecting studiesWe included randomised controlled trials enrolling adult women with overweight or obesity that evaluated structured exercise interventions, including aerobic exercise, resistance training, aerobic exercise with resistance training, high-intensity interval training or whole-body vibration training. Eligible studies compared these interventions with control conditions or other exercise modalities and reported at least one body composition outcome, including body fat percentage, body mass index, fat mass, lean body mass or waist circumference.Data extraction and synthesisTwo independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Cochrane Collaboration and Evidence Project tools. Network meta-analysis was conducted using random effects models. Confidence in the estimates was assessed using the CINeMA approach.Results43 randomised controlled trials involving 2315 women were included. For body fat percentage, aerobic exercise with resistance training, high-intensity interval training and aerobic exercise across varying intensities were associated with greater reductions relative to control conditions, with vigorous aerobic exercise showing the highest probability of benefit. A similar pattern was observed for other adiposity-related outcomes: vigorous aerobic exercise appeared most favourable for body mass index, high-intensity interval training for fat mass and moderate to vigorous intensity aerobic exercise for waist circumference. No intervention was associated with statistically significant improvements in lean body mass compared with control; however, resistance training demonstrated a comparatively favourable ranking profile.ConclusionsStructured exercise confers meaningful improvements in adiposity among women, particularly with aerobic-based modalities, whereas effects on lean mass remain limited. These results underscore the importance of tailored exercise strategies for optimising body composition in female populations.PROSPERO registration numberCRD420251161064.

Metabolic impact of exercise timing: Myonectin dynamics in overweight and obese postmenopausal women following high-intensity interval training.